Are US Munitions to Blame for Basra Birth Defects?

The guns have been silent in Iraq for years, but in Basra and Fallujah the number of birth defects and cancer cases is on the rise. Locals believe that American uranium-tipped munitions are to blame and some researchers think they might be right.

It sounds at first as if the old man were drunk. Or perhaps as though he had been reading Greek myths. But Askar Bin Said doesn't read anything, especially not books, and there is no alcohol in Basra. In fact, he says, he saw the creatures he describes with his own eyes: "Some had only one eye in the forehead. Or two heads. One had a tail like a skinned lamb. Another one looked like a perfectly normal child, but with a monkey's face. Or the girl whose legs had grown together, half fish, half human."

The babies Askar Bin Said describes were brought to him. He washed them and wrapped them in shrouds, and then he buried them in the dry soil, littered with bits of plastic and can lids, of his own cemetery, which has been in his family for five generations. It's a cemetery only for children.

Though they are small, the graves are crowded so tightly together that they are almost on top of one another. They look as if someone had overturned toy wheelbarrows full of cement and then scratched the names and dates of death into it before it hardened. In many cases, there isn't even room for the birth date. But it doesn't really matter, because in most cases the two dates are the same.

There are several thousand graves in the cemetery, and another five to 10 are added every day. The large number of graves is certainly conspicuous, says Bin Said. But, he adds, there "really isn't an explanation" for why there are so many dead and deformed newborn babies in Basra.

Others, though, do have an idea why. According to a study published in September in the Bulletin of Environmental Contamination and Toxicology, a professional journal based in the southwestern German city of Heidelberg, there was a sevenfold increase in the number of birth defects in Basra between 1994 and 2003. Of 1,000 live births, 23 had birth defects.

Double and Triple Cancers

Similarly high values are reported from Fallujah, a city that was fiercely contested in the 2003 war. According to the Heidelberg study, the concentration of lead in the milk teeth of sick children from Basra was almost three times as high as comparable values in areas where there was no fighting.

Never before has such a high rate of neural tube defects ("open back") been recorded in babies as in Basra, and the rate continues to rise. The number of hydrocephalus ("water on the brain") cases among newborns is six times as high in Basra as it is in the United States, the study concludes.

Jawad al-Ali has worked as a cancer specialist at the Sadr Teaching Hospital (formerly the Saddam Hospital), housed in a sinister-looking building in Basra, since 1991. He remembers the period after the first Gulf war over Kuwait. "It isn't just that the number of cancer cases suddenly increased. We also had double and triple cancers, that is, patients with tumors on both kidneys and in the stomach. And there were also familial clusters, that is, entire families that were affected." He is convinced that this relates to the use of uranium ammunition. "There is a connection between cancer and radiation. Sometimes it takes 10 or 20 years before the consequences manifest themselves."

The term uranium ammunition refers to projectiles whose alloys or cores are made with "depleted," or weakly radioactive uranium, also known as DU. When German soldiers are deployed overseas, they are given the following information: "Uranium munitions are armor-piercing projectiles with a core of depleted uranium. Because of its high density, this core provides the projectile with very high momentum and enables it to pierce the armor of combat tanks."

When DU explodes, it produces a very fine uranium dust. When children play near wrecked tanks, they can absorb this dust through their skin, their mouths and their airways. A 2002 study at the University of Bremen in northern Germany found that chromosomal changes had occurred in Gulf war veterans who had come into contact with uranium ammunition.

The German Defense Ministry counters that it isn't the radiation that constitutes a health threat, but the "chemical toxicity of uranium."

Living in a Garbage Dump

London's Royal Society presented one of the most comprehensive studies on the issue in 2002, but it only addressed the potential threat to soldiers. It concluded that the risk of radiation damage is "very low," as is the risk of chronic kidney toxicity from uranium dust.

This may reassure soldiers, but not Mohammed Haidar. He lives in Kibla, a district in Basra which, like others in the city, resembles nothing so much as a garbage dump. Kibla is a neighborhood of squalid, make-shift shops and shacks — with shimmering, greenish liquid flowing through open sewers and plastic containers filled with rotting material.

Haidar, who teaches mathematics at a high school, could afford to live in a better neighborhood. But he spends every spare dinar on treatment for his daughter Rukya. The three-year-old is sitting on his lap, resembling a ventriloquist's doll. She is an adorable little girl with pigtails and ribbons in her hair. But she can't walk or speak properly.

When Haidar turns his daughter around, two openings in her back become visible. She has a cleft spine, the externally visible sign of hydrocephalus, as well as an implanted drainage tube to remove excess cerebrospinal fluid. In Germany, children with cases like hers are often treated with prenatal surgery, but not in Basra. In fact, Haidar and his wife are glad that Rukya is even alive. She is their first and only child. "We both grew up in Basra. I hold the United States responsible. They used DU. My child isn't an isolated case," Haidar says.

The term "DU" seems to be just as widespread in Basra as birth defects are.

DU ammunition was used twice in the Basra district: outside the city in the 1991 war, and in the city proper in 2003, when British troops were advancing toward the airport. West Basra is the urban district with the highest incidence of leukemia among infants.

"Those who were children in the first war are adults today," says Khairiya Abu Yassin of the city's environmental agency. She estimates that 200 tons of DU ammunition were used in Basra. The Defense Ministry in London claims that British troops used only about two tons of DU ammunition during the war. Either way, the remains of tanks destroyed in the war with the help of DU ammunition littered the streets until 2008.

Propaganda Fodder

It was impossible to keep children and salvagers away from the wrecks, says Abu Yassin. "We installed signs that read: Caution — Radiation. But people don't take a threat seriously when it doesn't act like the bullet from a gun."

DU is a sensitive issue, and not every doctor in Basra is willing to go on record commenting on it. The reasons for the reticence have to do with the dictatorial regime of Saddam Hussein: The alleged radiation threat coming from remnants of armor-piercing ammunition provided popular propaganda fodder.

In the United States, no major newspaper has yet published a story on the genetic disorders in Fallujah. Britain's Guardian, on the other hand, criticized the silence of "the West," calling it a moral failure, and cited chemist Chris Busby, who said that the Fallujah health crisis represented "the highest rate of genetic damage in any population ever studied." Busby is the co-author of two studies on the subject.

Still, it is difficult to precisely pinpoint the cause of the defects. Spinal chord abnormality can also be triggered by a folic acid deficiency at the beginning of pregnancy, for example. Furthermore, very few Iraqis can afford regular pregnancy exams. As a result, many defective embryos are carried to full term, in contrast to what normally happens in Europe or the US.

Wolfgang Hoffmann, an epidemiologist at the University of Greifswald in northeastern Germany, has been collaborating with fellow scientists in Basra for years. "Birth defects often look very disturbing in photos," he says. "But they are always isolated cases and are not necessarily useful for identifying trends."

Hoffmann cites the lack of comprehensive data and questions the epidemiological reliability of reports. He does believe, however, that indications of increasing rates of cancer in Basra should be taken very seriously, partly because the data for Basra is more reliable.

Part 2: Searching for the Truth

The "plausible risk factors" for childhood leukemia, says Hoffmann, "undoubtedly include the contaminated environment, but also the lack of prevention, the trauma suffered by parents and the devastated medical infrastructure." The statistical increase in the number of children with leukemia since 1993 is also a function of cases not having been fully documented before 2003.

Janan Hassan, an oncologist with the Basra Children's Hospital, participated in a study that was just published in the Medical Journal of the Sultan Qaboos University in Oman. It states that although the rate of childhood leukemia in Basra remained stable between 2004 and 2009, compared with other countries in the region, there is a trend toward very young children contracting the disease.

As such, she believes that objections are only partially applicable. There is a "strong increase" of genetic defects as a cause of leukemia, she notes. "And the cases are coming from precisely the areas where there was heavy fighting. How do you explain that? By saying that reporting requirements have changed?"

Sabria Salman named her son Muslim, but it didn't protect him. Muslim, now 10, recently underwent surgery to remove a 500-gram tumor on his upper arm. He doesn't scream in pain anymore. Instead, the boy has a permanent grin on his face, as if he no longer had the strength to change his expression. He perspires heavily and has trouble breathing. There is a drain tube protruding from his left arm, and the right arm is wrapped in a dressing that's stained red along the edges.

Salman calls it "cancer in the muscles." The boy broke his shoulder two years ago, and since then his body has made little progress towards healing.

'Bombs in Our Neighborhood'

The hospital pays for the chemotherapy, although radiation therapy would be more effective for his tumor. But radiation is only available abroad or in Baghdad, where there is a five-month waiting list — and the family doesn't have that much time anymore. The mother prays to Allah, and when the interpreter asks her who is to blame for her son's affliction, she says: "The war is to blame. The pollution. There were many bombs in our neighborhood."

Uranium may be a factor, but other substances used in the production of ammunition and bombs are also implicated, toxic heavy metals like lead and mercury. "The bombardment of Basra and Fallujah may have increased the population's exposure to metals, possibly resulting in the current increase in birth defects," states the Heidelberg study.

Furthermore, when the Rumaila oil field near Basra was set on fire in 2003, a cloud of soot full of carcinogenic particles drifted across the city. And another factor could also be at play. Since Saddam was overthrown, Iraq's neighbors, Iran, Syria and Turkey, have diverted substantially more water from the Euphrates and Tigris Rivers. The current in the Shatt-al-Arab, formed by the confluence of the two rivers, is now so weak that salt water penetrates inland from the Persian Gulf all the way to Basra.

This means that wastewater from industrial facilities downstream from Basra, like the Iranian oil refinery in Abadan, are no longer being adequately diluted, increasing the concentration of heavy metals in groundwater.

Abu Ammar lives with his family on the grounds of Saddam's former navy command center. The quarters are cramped, with 10 people in a room, and the situation of several other families on the grounds is no better. It is yet another impoverished Basra neighborhood — the riches of the Basra oil wells, omnipresent in the neighborhood in the shape of stinking fumes, have yet to trickle down to the people.

Three Eyes for Three Children

Ammar has spread out a plastic rug on the floor and placed a can of 7-Up and a pastry for each of his visitors on the rug. The family — or what is left of it — squats around the rug. Saddam's thugs executed two of Ammar's brothers. The cousin sitting next to him still has a piece of shrapnel from an attack wedged behind his eye, the mother died of grief, his wife no longer goes outside — "and these are our children…," he says.

He points to a 21-year-old woman, a seven-year-old girl and a little boy, sitting next to each other. They don't have the same parents, but all three have the same narrow faces, and together they have only three eyes.

The sockets of their missing eyes look like the inside of an oyster, milky and shapeless. The young woman, Madia, attends the local college. She doesn't like going there, she says, even though she covers half of her face with her veil. "What caused this? I think my mother inhaled something chemical when I was inside of her," says Madia.

It's easy to assign the blame for these eerie birth defects to something called "DU ammunition," made in the USA. It's easier than thinking about the deleterious effects of lead and mercury in the soil and the tomatoes, or of the soot in the air and the toxic materials in the water. But that doesn't relieve those involved in the war from responsibility. It isn't enough to declare a war to be over. Even though Iraq now has elections and the tyrant has been hanged, the war is still in the soil, in the air and in the children.

Omran Habib heads the Basra Cancer Research Group. He earned his Ph.D. in London and now works as an epidemiologist at the University of Basra Hospital. "The war did an enormous amount of damage here," he says. "DU is certainly not good for our health. Nevertheless, even the presence of uranium in the urine of patients doesn't imply causation."

A Bundle in White

The World Health Organization (WHO) is currently assembling a report on DU ammunition. It will reflect the current state of research on the issue, but it will hardly provide any new insights. With the help of the University of Greifswald, a cancer registry has been developed for the Basra region and will serve as the basis for all future study. Still, even as further research is needed, if only for the children's sake, it will come too late for many.

It's certainly too late for the body lying inside a little white bundle of material, tied together at both ends like a piece of candy, lying on a pile of dirt along the edge of the children's cemetery in Basra. It was supposed to be his first son, says the father, standing next to the body. Yesterday the child was still moving inside the mother's stomach. Today the father was simply handed a bundle.

The body-washer on duty sighs loudly while digging the grave, hoping to increase his baksheesh. Then he places the bundle into the hole, says a few words of prayer, makes some adjustments to the bundle and covers it with earth. Off to the side, a chicken is pecking at a piece of a "Capri Sun" container sticking out of the soil.

Afterwards the men smoke. The father is given a piece of cardboard and writes down the name of his son, copying it from the combined birth and death certificate they gave him at the hospital. The gravedigger will scratch the name into the cement. The boy was going to be named Hussein Ali. The father writes the name of his dead child for the first and last time.

The man remains motionless. Who wonders about blame at such a moment? He seems empty, completely at a loss and robbed of a tiny life.